South African Psychiatry - February 2019

FEATURE
TV) why the patients had been transferred against
all advice from others, her response was: “How
could they know? Unless they are foretellers” with
reference to the expert advice given by professional
bodies. Again during the ADR process Ms Mahlangu
stated: “If I were a prophet justice, I would have had
foresight.”
THIS, IN ESSENCE, IS THE DIFFICULTY: SOME
FORESIGHT COMES FROM TAKING THE
DICTATES OF REALITY AND KNOWLEDGE
SERIOUSLY, LEARNING FROM HARD
EARNED EXPERIENCE AND LISTENING TO
OTHERS WITHOUT NECESSARILY ACCEPTING
RECEIVED WISDOM UNCRITICALLY.
In the report I wrote that The Decanting turned a
blind eye to all available psychiatric, psychological
and sociological research, evidence and theory
regarding the likely negative impact of relocating
such a large number of institutionalised patients and
that it ignored all available expertise and knowledge
gained from clinical and ordinary experience in the
manner of relocation (Trotter et al., 2017). There was
foresight in this case but the subject in question
could not believe her eyes.
Ten pages of Justice Moseneke’s award (Moseneke,
2018) detail how this allowed the statutory substrate of
social and cooperative living to carry no meaningful
weight, authority or substance in actual reality:
“What stands out is the breadth and depth and
frequency of the arrogant and deeply disgraceful
disregard of constitutional obligations, other law,
mental health care norms and ethics by an organ
of state, its leaders and employees” (p. 72). During
the arbitration Dr Mvuyiso Talatala said that he knew
time would tell when asked why further legal action
had not been taken to halt the Marathon Project.
And indeed it did as time is beyond omnipotent
control.
Once the infant has essentially turned away from
reality and mourning the premature mind can
further distort and reshape itself in various ways in
order to deal with the incessant demand of internal
forces. A few thoughts regarding this follow. Freud
(1938) describes how the mind can cleave in two
in the presence of intense conflict between wishing
and reality: reality, on the one hand, is rejected and
prohibitions are refused while, on the other hand, the
danger of reality is simultaneously recognised. The
mind both affirms and negates reality and nothing
is given up. But, as Freud reminds us, we always have
to pay the piper. The cost here is a rift in the ego
which never heals. Rather two contrary reactions to
the conflict persist as the centre-point of a splitting
of the ego rather than as a dialectical tension
because things never fit and have to be continually
manipulated and distorted.
This results in a double articulation or pivot in the
mind which allows rotation and oscillation between
contradictory points of view. Donald Trump refers to
these as ‘alternative facts’ which can be used to spin
reality rather than confront it.
THIS WAY OF DEALING WITH REALITY
DESERVES TO BE DESCRIBED AS ARTFUL
AND INGENIOUS SAYS FREUD (1938). THE
SLIPPERY SLOPE OF FUDGING REALITY
RENDERS TRUTH OBSOLETE IN SUCH
SCENARIOS. IF IT IS DISAGREEABLE IT IS
‘FAKE NEWS’ WHICH ALLOWS AN EVEN
MORE SPURIOUS VERSION OF EVENTS TO
BE RELAYED AS HISTORICAL TRUTH.
We could say that this way of dealing with reality is
manipulative and perverse. This use of ‘alternative
facts’ or misinformation was evident throughout
the GMHMP. The Department perjured itself in court
at the outset (March 2016) in order to push the
Marathon Project forward against all opposition. Ms
Mahlangu did not present the facts accurately to the
provincial legislature in 2016 and Dr Manamela had
compiled the response. Ms Mahlangu, Dr Selebano
and Dr Manamela all pleaded ignorance regarding
the fact that by August 2016 fifty one people had
already died. As Justice Moseneke (2018) states:
“This answer is as improbable as it is untrue.”
Licensing fraud and unlawful licensing of NGOs
became the new ethical norm. The families were
subjected to relentless violations of trust, continual
stonewalling and incessant deception.
CROSS-EXAMINATION IS A TOUGH
PROCESS AND YET THE TRIUMVIRATE
WERE ABLE TO CONTRADICT THEMSELVES
ON THE STAND, OBFUSCATE THE FACTS
AND REMAIN UNTOUCHABLE IN TERMS OF
AN IMPERATIVE TO TELL THE TRUTH EVEN
UNDER OATH AND JUSTICE MOSENEKE’S
WARNINGS: “IT IS JUST A MATTER OF TIME
BEFORE I DECIDE WHETHER YOU ARE
TELLING THE TRUTH OR NOT.”
Essentially reality became plastic and could be
manoeuvred and morphed at will. In his award Justice
Moseneke (2018) described parts of the testimony
of the triumvirate as misleading, improbable and
inaccurate and finally stated that many of the reasons
presented were “false, disingenuous, and advanced
in order to conceal the true reasons for ending
the contract and moving the patients” (p. 19). Ms
Mahlangu was actually able to express the operation
of the pivot in her mind. She said that if she answered
yes or no it wouldn’t be good for her, a privilege not
allowed many individuals who took the stand. She
begged the indulgence of the court continually to
present, explain and overelaborate a perspective
of the relocation which was totally detached from
what had transpired in the real world. And she clung
tenaciously to discredited reasons for the relocation
such as cost cutting, deinstitutionalisation and
promoting community care.
22 * SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019